Q. Daughter in Australia diagnosed with BPD 4 yrs ago & until that time had no apparent symptoms and seemed to be functioning well.. Has been institutionalized many times & frequently in closed wards. Attends therapy sessions twice weekly and is on medication. We are very close & I have visited her for short periods of time but each time upon leaving, she has a sense of abandonment. My concern is keeping her alive...she cuts herself & overdoses, resulting in commitment to psych facilities. Question: would it be helpful if I stayed with her for an extended time to circumvent the suicide attempts and work with her and the therapist in modifying this behavior? Also, she has sent me info re DBT (Dialectical Behavior Therapy) and will be discussing this approach with her therapist. Do you recommend same?

Thank you for any assistance you can give. She is such a dynamic person; loving, sensitive and very bright & we will do anything to make her well.

A. DBT is a fine form of therapy, but will likely be useless without your daughter being on the correct medications. I have written a number of letters on the medications, and dosing them. Make sure she is on one at an adequate dosage before starting her in therapy. Therapy without medications is like talking to diabetes to lower the blood sugar. It does not work. You give insulin, and then teach people about diet, exercise, etc. Correct ordering of interventions is imperative. Staying with your daughter is not going to help. Abandonment, as well as cutting and suicidality, are logical behaviors of her illness based on its biochemistry. Staying with her will not change the chemistry. Medications change chemistry.